Associations 1 Flashcards
Meningitis + petechiae/purpura
Neisseria meningitis
Temporal lobe encephalitis + skin lesions
Herpes simplex virus
Meningitis + AMS
Encephalitis
WNV animals
Birds are reservoir, mosquitoes are vector
Virus + ASA
Reye syndrome (brain + liver)
Ring enhancing lesion on MRI
Brain abscess
Poliomyelitis
Destroys motor neurons (flaccid paralysis)
Negri bodies (eosinophilic inclusions in neurons)
Rabies
HA made worse by foods w/ tyramine
Migraine
HA in obese woman w/ papilledema
Pseudotumor cerebri
Jaw muscle pain when chewing
Temporal (giant cell) arteritis
Periorbital pain w/ ptosis and miosis
Cluster HA
Horner’s syndrome - 2 causes
Ptosis, miosis, anhydrosis Pancoast tumor (apex of lung), Cluster HA (partial)
HA w/ photophobia and/or phonophobia
Migraine
HA w/ b/l frontal/occipital pressure
Tension
HA w/ lacrimation and/or rhinorrhea
Cluster
HA w/ elevated ESR
Temporal (giant cell) arteritis
“Worst HA of my life”
SAH
HA + extraocular muscle palsies
Cavernous sinus thrombosis
Scintillating scotomas prior to HA
Migraine w/ aura
HA associated with sex (before/after orgasm)
Post coital cephalgia
HA responsive to 100% O2
Cluster
Frontal HA made worse by bending over
Sinus
Trauma to head leading to HA that begins days later, persists for over a week and doesn’t go away
Subdural hematoma
Trigeminal neuralgia first line Rx
Carbamazepine
UMN s/sx
Spasticity, increased DTR, positive Babinski sign
Slowed rapid alternating movements, gait disorder
Movement stiffness, slowness, incoordination
LMN s/sx
Flaccid paralysis, decreased DTR, fasciculations, muscle atrophy
Weakness, gait disorder
Bulbar UMN s/sx
Dysphagia, dysarthria
Pseudobulbar: inappropriate laughing, crying, yawning
Two symptoms = MS
Unilateral optic neuritis
Internuclear ophthalmoplegia
Eye pain worse with movement, central vision loss, afferent pupillary defect
Optic neuritis –> MS
Ipsilateral loss of adduction on lateral gaze + contralateral nystagmus + intact convergence
Internuclear ophthalmoplegia –> MS
Marcus Gunn pupil
Optic nerve injury or retinal detachment
Fail swinging flashlight test
Afferent pupillary defect
Dementia with Parkinsonian features
Lewy body dementia
Dementia with visual hallucinations
Lewy body dementia
Dementia with syncope / repeated falls
Lewy body dementia
Dementia with behavior or personality changes
Frontotemporal dementia (Pick disease)
Dementia with progressive aphasia
Frontotemporal dementia (Pick disease)
Dementia work-up
MMSE
Electrolytes, BUN/Cr, LFT, Ca, CBC, UA, RPR, HIV, TSH, B12
MRI of brain
Bilateral facial weakness
Guillain-Barre syndrome Lyme disease (b/l Bell's palsy)
Upper and lower facial weakness
Bell’s palsy
Causes of Bell’s palsy
Lyme disease
Herpes Zoster, AIDS, sarcoid, tumors
Diabetes
Muscle weakness worse w/ use, what is next step?
Myasthenia gravis; CT chest for thymoma
Muscle weakness better w/ use, associated?
Lambert-Eaton; small cell lung cancer
Ptosis and Diplopia, young woman
Myasthenia gravis
Ascending bilateral weakness post recent viral illness
Guillain-Barre syndrome
Guillain-Barre associated viral illnesses
Campylobacter jejuni diarrhea (20%)
HIV, CMV, EBV, Mycoplasma, other viruses, immunizations (rare)
Chorea
Hyperthyroidism Huntington SLE Rheumatic fever Levodopa use
Athetosis
Cerebral palsy
Encephalopathy, Huntington, Wilson
Dystonia
Parkinson
Neuroleptic use
Wilson, Huntington, encephalitis
Hemiballismus
Stroke (subthalamic nucleus)
Tics
Tourette syndrome
OCD, ADHD
MC brain tumors in adults
MGM Studios Metastases Glioblastoma (prognosis = 6 months) Meningtioma Schwannoma
MC brain tumors in children
Animal Kingdom, Magic Kingdom, Epcot
Astrocytoma (benign)
Medulloblastoma (malignant)
Ependymoma (may be malignant)
Metastatic CNS neoplasms - from where
Lots of Bad Stuff Kills Glia Lung Breast Skin (melanoma) Kidney (RCC) GI (CRC)
Neurofibromatosis Type I - S/Sx
AD on chromosome 17 COFFINS Cafe-au-lait spots Optic glioma Freckling (axillary/inguinal) Family hx Iris hamartomas (Lisch nodules) Neurofibromas Skeletal lesions
Neurofibromatosis Type II
AD on chromosome 22
Bilateral acoustic neuromas (schwannomas) - hearing loss
Syncope causes
Reflex (vasovagal, situational) Carotid-sinus hypersensitivity Cardiogenic Orthostatic Cerebrovascular Idiopathic (>20%)
Syncope work-up
Tilt test R/o seizure by H&P Cbc, electrolytes, BUN/Cr, glucose Assess volume statis Pulse ox and EKG Evaluate medications Carotid sinus massage (patients >40 w/o carotid disease or bruit) Also consider: serial cardiac enzymes/EKG x3, echocardiogram, cardiac stress test, bilateral carotid duplex, 24 hr Holter monitor, CT head and EEG
Seizure vs syncope vs nonspecific
Prodrome of deja-vu, aura; postictal confusion, tongue lacerations vs Prodrome of sweating, lightheadedness; hx prolonged standing
Nonspecific: brief limb jerking, urinary incontinence
Diff Dx in ER for LOC
AEIOU TIPS Alcohol Epilepsy/environmental (hypothermia) Insulin (+/-) OD/opioids Uremia Trauma Infection Psychogenic Stroke
Arnold Chiari malformation associated abnormalities
Hydrocephalus
Syringomyelia
Myelomeningocele
RB gene
Retinoblastoma
Osteosarcoma
Cherry red spots on retina
Tay Sachs
Niemann-Pick
Central retinal artery occlusion
Hydrocephalus in children
Arnold Chiari type II
Dandy Walker malformation
Tay Sach’s disease
Ashkenazi Jews
Cherry red spot on retina
Blown/dilated pupil
CNIII lesion (parasympathetic fibers)
MLF syndrome (maintains conjugate gaze when one eye abducts)
Bilateral - MS
Unilateral - stroke
Bitemporal hemianopia
Optic chiasm lesion (pituitary adenoma)
Argyll Robertson pupil
Accommodates to near objects, nonreactive to light
Syphilis (prostitute’s eye)
SLE, DM
Adie pupil
Minimally reactive dilated pupil
Abnormal innervation of iris (usu inflammation from former infection)
Uveitis - associated diseases
Seronegative spondyloarthropathies (-RF): psoriatic arthritis, ankylosing spondylitis, inflammatory bowel diseases (esp UC), reactive arthritis Juvenile idiopathic arthritis Behcet's disease, Sarcoidosis, Kawasaki disease
MCC blindness over age 55
Macular degeneration
MCC blindness under age 55
Diabetes mellitus
MCC blindness in blacks
Glaucoma
Bacterial conjunctivitis
Purulent, copious discharge 24 hrs/day
S. aureus, S. pneumo, N. gonorrhea, Chlamydia
Viral conjunctivitis
Watery discharge, eyelid may be sealed shut in AM
May also have fever, URI, lymphadenopathy, pharyngitis
Adenovirus